title: Hyperbilirubinemia as a predictor for appendiceal perforation: a systematic review.
abstract: OBJECTIVE
  Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum bilirubin as a predictor for appendiceal perforation.
  
  
  METHODS
  Medline, Embase, and Cochrane databases were searched for studies evaluating elevated bilirubin in the diagnosis of perforated appendicitis. Study selection criteria included English language papers evaluating serum bilirubin as a marker of appendiceal perforation in humans. A total of 189 abstracts were screened for eligibility, of which five clinical studies were included in this study.
  
  
  RESULTS
  Bilirubin was significantly higher in patients with appendiceal perforation compared with patients with appendicitis without perforation. Elevated serum bilirubin had a sensitivity ranging from 0.38 to 0.77 and a specificity ranging from 0.70 to 0.87 in predicting appendiceal perforation.
  
  
  CONCLUSIONS
  Elevated serum bilirubin for determining the risk of perforation in appendicitis has low sensitivity but higher specificity. This measure can therefore be used as a supplement in the diagnostic process.
authors.affiliation: Department of Surgery D, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Burcharth
authors.forename: H C
authors.initials: HC
authors.lastname: Pommergaard
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
authors.forename: I
authors.initials: I
authors.lastname: Gögenur
mesh_terms: D001064:Appendicitis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000209:etiology*; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D001663:Bilirubin
keywords: Surgery; appendicitis; appendix; bilirubin; hyperbilirubinemia; perforation; serological markers